Claims Processor, Intermediate [Remote] Job Vacancy in Blue Shield of California Redding, CA 96002 – Latest Jobs in Redding, CA 96002
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Company Name : Blue Shield of California
Location : Redding, CA 96002
Position : Claims Processor, Intermediate [Remote]
Job Description : Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!
Your Role
The Claims processor is responsible for processing work in claims, provider, or other operational areas to meet operational, financial, and service requirements including timely and proper enrollment, adjudication of claims, or provider demographics updates in accordance with contractual requirements.
In this role, you will review and adjudicate complex/specialty paper/electronic claims. You will also determine whether to return, deny, or pay claims following organizational policies and procedures, and provide guidance or expertise to less experienced claims processors. **Work mode: This position is remote.
Your Work
In this role, you will:
Be experienced in back-end processing; proficient in resolving complex edits using available documents/job aids with minimum direction.
Experience front-end processing and difficult adjustments.
Be given special processing assignments and coordinate with other departments for resolution if needed.
Understand fundamentals of end-to-end (life of a clam) claims processing.
Perform established performance metrics.
Your Knowledge and Experience
Requires a high school diploma or GED.
Requires 3 years of claims processing or health care experience.
Knowledge of medical plans and benefits preferred.
Experience with FACETS preferred.
Experience creating documents/files using Excel, Outlook, Power Point, and Word preferred.
Our Values
Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we’re going to do and by acknowledging and correcting where we fall short.
Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
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